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Rybczynska DN, Markiet KE, Pienkowska JM, Szurowska E, Frydrychowski A. To assess the quantitative features of focal liver lesions in gadoxetic acid enhanced MRI and to determine whether these features can accurately differentiate benign form malignant lesions. Eur J Radiol 2024; 171:111288. [PMID: 38194844 DOI: 10.1016/j.ejrad.2024.111288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/07/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
PURPOSE The study aims at assessing the quantitative features which distinguish focal liver lesions (FLLs) in gadoxetic acid (GA) enhanced liver MRI and at determining whether these features can accurately differentiate benign from malignant lesions. MATERIAL AND METHODS 107 patients with 180 unequivocal FLLs in previous examinations were included in a single-center retrospective study. All patients underwent a MRI test of the liver with GA. 99 benign and 74 malignant lesions were included. The group of benign lesions consisted of 60 focal nodular hyperplasias (FNH), 22 hemangiomas (HMG), 6 hepatic adenomas (HA), and 11 other benign lesions (1 angiomyolipioma, 6 lesions histopathology diagnoses as benign without further specification, or ones lacking features of malignancy, and 4 lesions radiologically diagnosed as benign which remained stable in the follow-up studies). The group of malignant lesions consisted of primary 51 hepatocellular carcinomas, 12 metastases, and 11 metastases from melanoma malignum (MM meta). 7 FLLs were excluded (4 cases of uncertain histopathological diagnosis, 2 cholangiocarcinomas, and 1 regenerative nodule). For the included lesions ROI (region of interest) measurements were taken by two observers in the T2-w, ADC (apparent diffusion coefficient) and in the T1-w sequence in the hepatobiliary phase (HBP). The interobserver agreement was evaluated with the Wilcoxon test. The Kruskal - Wallis, Mann - Whitney U and post hoc Dunn's tests were applied to assess if there were any significant differences in the ROI values between individual lesions. The variables with the p values of < 0.05 were considered statistically significant. RESULTS We found significant differences in the ROI values between lesions with p < 0.0001. Strikingly high ROI values in the T2-w sequence were found for HMG. The lowest ADC values were encountered for metastases and MM metastases. The highest ROI values in the HBP were found for FNH, and the lowest for metastases. We also found statistically significant differences in the ROI values between benign and malignant lesions with benign lesions presenting statistically higher ROI values compared to malignant lesions. CONCLUSIONS There were significant differences in the ROI values among different types of FLLs. The predominant quantitative feature in the T2-w sequence was a strikingly high ROI value for HMG. Benign lesions presented statistically higher ROI values in the T2-w, ADC, and HBP sequences compared to malignant lesions. This was true for all lesions except for HA.
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Affiliation(s)
- Dorota N Rybczynska
- 2(nd) Department of Radiology, Medical University of Gdansk, Gdansk, Poland; Institute of Human Physiology, Medical University of Gdansk, Gdansk, Poland.
| | - Karolina E Markiet
- 2(nd) Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
| | - Joanna M Pienkowska
- 2(nd) Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
| | - Edyta Szurowska
- 2(nd) Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
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Geng R, Zhang Y, Rice J, Muehler MR, Starekova J, Rutkowski DR, Uboha NV, Pirasteh A, Roldán-Alzate A, Guidon A, Hernando D. Motion-robust, blood-suppressed, reduced-distortion diffusion MRI of the liver. Magn Reson Med 2023; 89:908-921. [PMID: 36404637 PMCID: PMC9792444 DOI: 10.1002/mrm.29531] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate feasibility and reproducibility of liver diffusion-weighted (DW) MRI using cardiac-motion-robust, blood-suppressed, reduced-distortion techniques. METHODS DW-MRI data were acquired at 3T in an anatomically accurate liver phantom including controlled pulsatile motion, in eight healthy volunteers and four patients with known or suspected liver metastases. Standard monopolar and motion-robust (M1-nulled, and M1-optimized) DW gradient waveforms were each acquired with single-shot echo-planar imaging (ssEPI) and multishot EPI (msEPI). In the motion phantom, apparent diffusion coefficient (ADC) was measured in the motion-affected volume. In healthy volunteers, ADC was measured in the left and right liver lobes separately to evaluate ADC reproducibility between the two lobes. Image distortions were quantified using the normalized cross-correlation coefficient, with an undistorted T2-weighted reference. RESULTS In the motion phantom, ADC mean and SD in motion-affected volumes substantially increased with increasing motion for monopolar waveforms. ADC remained stable in the presence of increasing motion when using motion-robust waveforms. M1-optimized waveforms suppressed slow flow signal present with M1-nulled waveforms. In healthy volunteers, monopolar waveforms generated significantly different ADC measurements between left and right liver lobes ( p = 0 . 0078 $$ p=0.0078 $$ , reproducibility coefficients (RPC) = 470 × 1 0 - 6 $$ 470\times 1{0}^{-6} $$ mm 2 $$ {}^2 $$ /s for monopolar-msEPI), while M1-optimized waveforms showed more reproducible ADC values ( p = 0 . 29 $$ p=0.29 $$ , RPC = 220 × 1 0 - 6 $$ \mathrm{RPC}=220\times 1{0}^{-6} $$ mm 2 $$ {}^2 $$ /s for M1-optimized-msEPI). In phantom and healthy volunteer studies, motion-robust acquisitions with msEPI showed significantly reduced image distortion ( p < 0 . 001 $$ p<0.001 $$ ) compared to ssEPI. Patient scans showed reduction of wormhole artifacts when combining M1-optimized waveforms with msEPI. CONCLUSION Synergistic effects of combined M1-optimized diffusion waveforms and msEPI acquisitions enable reproducible liver DWI with motion robustness, blood signal suppression, and reduced distortion.
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Affiliation(s)
- Ruiqi Geng
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Medical Physics, University of Wisconsin-Madison, WI, USA
| | - Yuxin Zhang
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Medical Physics, University of Wisconsin-Madison, WI, USA
| | - James Rice
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, WI, USA
| | | | - Jitka Starekova
- Department of Radiology, University of Wisconsin-Madison, WI, USA
| | - David R. Rutkowski
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, WI, USA
| | - Nataliya V. Uboha
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin-Madison, WI, USA,UW Carbone Cancer Center, WI, USA
| | - Ali Pirasteh
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Medical Physics, University of Wisconsin-Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, WI, USA
| | | | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Medical Physics, University of Wisconsin-Madison, WI, USA,Department of Electrical and Computer Engineering, University of Wisconsin-Madison, WI, USA,Department of Biomedical Engineering, University of Wisconsin-Madison, WI, USA
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Ishii-Kitano N, Enomoto H, Nishimura T, Aizawa N, Shibata Y, Higashiura A, Takashima T, Ikeda N, Yuri Y, Fujiwara A, Yoshihara K, Yoshioka R, Kawata S, Ota S, Nakano R, Shiomi H, Hirota S, Kumabe T, Nakashima O, Iijima H. Multiple Inflammatory Pseudotumors of the Liver Demonstrating Spontaneous Regression: A Case Report. Life (Basel) 2022; 12:124. [PMID: 35054517 PMCID: PMC8779591 DOI: 10.3390/life12010124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/24/2022] Open
Abstract
Inflammatory pseudotumor (IPT) of the liver is a rare benign disease. IPTs generally develop as solitary nodules, and cases with multiple lesions are uncommon. We herein report a case of multiple IPTs of the liver that spontaneously regressed. A 70-year-old woman with a 10-year history of primary biliary cholangitis and rheumatoid arthritis visited our hospital to receive a periodic medical examination. Abdominal ultrasonography revealed multiple hypoechoic lesions, with a maximum size of 33 mm, in the liver. Contrast-enhanced computed tomography revealed low-attenuation areas in the liver with mild peripheral enhancement at the arterial and portal phases. We first suspected metastatic liver tumors, but fluorodeoxyglucose positron emission tomography, magnetic resonance imaging and contrast-enhanced ultrasonography suggested the tumors to be inconsistent with malignant nodules. A percutaneous biopsy showed shedding of liver cells and abundant fibrosis with infiltration of inflammatory cells. Given these findings, we diagnosed the multiple tumors as IPTs. After careful observation for two months, the tumors almost vanished spontaneously. Physicians should avoid a hasty diagnosis of multiple tumors based solely on a few clinical findings, and a careful assessment with various imaging modalities should be conducted.
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Affiliation(s)
- Noriko Ishii-Kitano
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Hirayuki Enomoto
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Takashi Nishimura
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (Y.S.); (A.H.)
| | - Nobuhiro Aizawa
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Yoko Shibata
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (Y.S.); (A.H.)
| | - Akiko Higashiura
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (Y.S.); (A.H.)
| | - Tomoyuki Takashima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Naoto Ikeda
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Yukihisa Yuri
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Aoi Fujiwara
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Kohei Yoshihara
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Ryota Yoshioka
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Shoki Kawata
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Shogo Ota
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Ryota Nakano
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Hideyuki Shiomi
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
| | | | - Osamu Nakashima
- Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume 830-0011, Fukuoka, Japan;
| | - Hiroko Iijima
- Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa-cho 1-1, Nishinomiya 663-8501, Hyogo, Japan; (N.I.-K.); (T.N.); (N.A.); (T.T.); (N.I.); (Y.Y.); (A.F.); (K.Y.); (R.Y.); (S.K.); (S.O.); (R.N.); (H.S.); (H.I.)
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (Y.S.); (A.H.)
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Cannella R, Sartoris R, Grégory J, Garzelli L, Vilgrain V, Ronot M, Dioguardi Burgio M. Quantitative magnetic resonance imaging for focal liver lesions: bridging the gap between research and clinical practice. Br J Radiol 2021; 94:20210220. [PMID: 33989042 PMCID: PMC8173689 DOI: 10.1259/bjr.20210220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Magnetic resonance imaging (MRI) is highly important for the detection, characterization, and follow-up of focal liver lesions. Several quantitative MRI-based methods have been proposed in addition to qualitative imaging interpretation to improve the diagnostic work-up and prognostics in patients with focal liver lesions. This includes DWI with apparent diffusion coefficient measurements, intravoxel incoherent motion, perfusion imaging, MR elastography, and radiomics. Multiple research studies have reported promising results with quantitative MRI methods in various clinical settings. Nevertheless, applications in everyday clinical practice are limited. This review describes the basic principles of quantitative MRI-based techniques and discusses the main current applications and limitations for the assessment of focal liver lesions.
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Affiliation(s)
- Roberto Cannella
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Section of Radiology - BiND, University Hospital "Paolo Giaccone", Via del Vespro 129, 90127 Palermo, Italy.,Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, 90127 Palermo, Italy
| | | | - Jules Grégory
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - Lorenzo Garzelli
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France
| | - Valérie Vilgrain
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,Université de Paris, Paris, France.,INSERM U1149, CRI, Paris, France
| | - Marco Dioguardi Burgio
- Service de Radiologie, Hôpital Beaujon, APHP.Nord, Clichy, France.,INSERM U1149, CRI, Paris, France
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Mahmood KA, Rashid RJ, Fateh SM, Mohammed NA. Evaluation of the Effect of Patient Preparation Using Castor Oil on ADC Value of Focal Liver Lesion. Int J Gen Med 2021; 14:469-474. [PMID: 33623419 PMCID: PMC7896795 DOI: 10.2147/ijgm.s289661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the role of patient preparation using castor oil on the ADC value of focal liver lesion. Patients and Methods Retrospective case-control study over more than two years. Magnetic resonance imaging (MRI) scan, including diffusion-weighted imaging (DWI) of the upper abdomen performed for 87 cases and 71 controls in patients with focal hepatic hemangiomas. Cases were prepared using castor oil prior to the scan without identifiable unwanted effect, while controls did not receive any special preparation. Since liver hemangioma is a common lesion, it was selected and used as a sample. Apparent Diffusion Coefficient (ADC) values of focal liver lesion were calculated in cases and controls. Results The mean ADC value of liver hemangioma was lower in cases compared to controls; the mean ADC value was (2.21±0.39x10ˉ3mm2/s) in cases and (2.51±0.49x10ˉ3mm2/s) in controls. Left lobes were more affected by lesions; the mean ADC value of the left lobe lesions was (2.26±0.37 x10ˉ3mm2/s) and (2.86±0.43 x10ˉ3mm2/s) in cases and controls, respectively. The ADC value of lesions in the right lobe was (2.19±0.39x10ˉ3mm2/s) in cases and (2.39± 0.45x10ˉ3mm2/s) in controls. There was a significant segmental ADC variation; lesions at segments II, III, IVb, and V demonstrated illusive ADC elevation in controls. Conclusion There is erroneous elevation of lobar and segmental ADC value of liver hemangiomas in non prepared patients. This Potential source of error (peristalsis, partial volume, and paramagnetic gas effect of gastrointestinal tract) on hepatic lesions’ ADC value can be avoided by proper preparation using castor oil prior to MRI scanning.
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Affiliation(s)
- Kawa Abdulla Mahmood
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Rezheen Jamal Rashid
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Salah Mohammed Fateh
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
| | - Naser Abdullah Mohammed
- University of Sulaimani, College of Medicine, Department of Surgery-Diagnostic Imaging Unit, Sulaymaniyah, Kurdistan Region, Iraq
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Lan H, Lin G, Zhong W. A meta-analysis of the added value of diffusion weighted imaging in combination with contrast-enhanced magnetic resonance imaging for the diagnosis of small hepatocellular carcinoma lesser or equal to 2 cm. Oncol Lett 2020; 20:2739-2748. [PMID: 32782590 PMCID: PMC7400770 DOI: 10.3892/ol.2020.11805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
Diffusion weighted imaging (DWI) has been found to increase the sensitivity in the diagnosis of small hepatocellular carcinoma (HCC), although additional studies are required to confirm its value. The aim of the present study was to explore the diagnostic performance of DWI combined with contrast-enhanced magnetic resonance imaging (MRI) for small HCC by performing a meta-analysis. Literature databases (PubMed, Embase, Web of Science and Cochrane Library databases) were searched to identify studies reporting the sensitivity and specificity of MRI with DWI for the diagnosis of small HCCs. Pooled sensitivity and specificity were generated using a bivariate random effect model. Multilevel mixed-effects logistic regression analysis was used to examine the value of DWI combined with conventional MRI. A total of 837 small HCCs and 545 benign liver lesions from 10 studies were included. The overall sensitivity and specificity of DWI combined with contrast-enhanced MRI was 0.88 (95% CI, 0.80-0.93) and 0.90 (95% CI, 0.81-0.95), respectively. Compared with that in contrast-enhanced MRI, DWI with contrast-enhanced MRI had a significantly higher sensitivity for the diagnosis of small HCC (P=0.01) while there was no significant difference in the specificity (P=0.603). The present meta-analysis suggests that DWI combined with contrast-enhanced MRI may increase the sensitivity, whilst maintaining high specificity for the diagnosis of small HCCs with a diameter ≤2 cm.
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Affiliation(s)
- Hailong Lan
- Department of Radiology, Wuchuan People's Hospital, Wuchuan, Guangdong 524500, P.R. China
- Department of Radiology, Xiaolan Hospital Affiliated to Southern Medical University, Zhongshan, Guangdong 528000, P.R. China
- Correspondence to: Dr Hailong Lan, Department of Radiology, Wuchuan People's Hospital, 12 Jiefang North Road, Wuchuan, Guangdong 524500, P.R. China, E-mail:
| | - Guisen Lin
- Department of Radiology, Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong 515000, P.R. China
| | - Weizhi Zhong
- Department of Radiology, Wuchuan People's Hospital, Wuchuan, Guangdong 524500, P.R. China
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